{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:19Z","timestamp":1787028619686,"version":"build-2736575974"},"reference-count":31,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T00:00:00Z","timestamp":1621555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background. Cardiogenic shock (CS) is the leading cause of in-hospital mortality in ST-segment elevation myocardial infarction (STEMI). Only limited data are available on the long-term outcome of STEMI patients with CS undergoing contemporary treatment. We aimed to investigate long-term mortality and its predictors in STEMI patients with CS and to develop a risk score for long-term mortality prediction. Methods and Results. We retrospectively included 465 patients with STEMI complicated by CS and treated with primary angioplasty and intra-aortic balloon pump between 2005 and 2018. Long-term mortality, including both in-hospital mortality and all-cause mortality following discharge from the index hospitalization, was the primary endpoint. The long-term mortality (median follow-up 4 (2.0\u20135.2) years) was 60%, including in-hospital mortality (34%). At multivariate analysis, independent predictors of long-term mortality were age (HR 1.41, each 10-year increase), admission left ventricular ejection fraction (HR 1.51, each 10%-unit decrease) and creatinine (HR 1.28, each mg\/dl increase), and acute kidney injury (HR 1.81). When these predictors were pooled together, the area under the curve (AUC) for long-term mortality was 0.80 (95% CI 0.75\u20130.84). Using the four variables, we developed a risk score with a mean (cross-validation analysis) AUC of 0.79. When the score was applied to in-hospital mortality, its AUC was 0.79, and 0.76 when the score was applied to all-cause mortality following discharge. Conclusions. In STEMI patients with CS, the risk of death is still substantial in the years following the index event. A simple clinical score at the time of the index event accurately predicts long-term mortality risk.<\/jats:p>","DOI":"10.3390\/jcm10112237","type":"journal-article","created":{"date-parts":[[2021,5,21]],"date-time":"2021-05-21T13:15:15Z","timestamp":1621602915000},"page":"2237","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["ST-Segment Elevation Acute Myocardial Infarction Complicated by Cardiogenic Shock: Early Predictors of Very Long-Term Mortality"],"prefix":"10.3390","volume":"10","author":[{"given":"Nicola","family":"Cosentino","sequence":"first","affiliation":[{"name":"Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta L.","family":"Resta","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1223-6128","authenticated-orcid":false,"given":"Alberto","family":"Somaschini","sequence":"additional","affiliation":[{"name":"Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology\u2014Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"},{"name":"Unit of Cardiology, Department of Molecular Medicine, Universit\u00e0 degli studi di Pavia, 271000 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeness","family":"Campodonico","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3119-7099","authenticated-orcid":false,"given":"Giampaolo","family":"D\u2019Aleo","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0190-6854","authenticated-orcid":false,"given":"Giovanni","family":"Di Stefano","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Lucci","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Moltrasio","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Bonomi","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4311-2139","authenticated-orcid":false,"given":"Stefano","family":"Cornara","sequence":"additional","affiliation":[{"name":"Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology\u2014Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"},{"name":"Unit of Cardiology, Department of Molecular Medicine, Universit\u00e0 degli studi di Pavia, 271000 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Demarchi","sequence":"additional","affiliation":[{"name":"Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology\u2014Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"},{"name":"Unit of Cardiology, Department of Molecular Medicine, Universit\u00e0 degli studi di Pavia, 271000 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"De Ferrari","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Mediche, Cardiologia Citt\u00e0 della Salute e della Scienza, Universit\u00e0 di Torino, 10126 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio L.","family":"Bartorelli","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"},{"name":"Department of Biomedical and Clinical Sciences \u201cLuigi Sacco\u201d, University of Milan, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4410-4461","authenticated-orcid":false,"given":"Giancarlo","family":"Marenzi","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1056\/NEJM199904153401504","article-title":"Temporal trends in cardiogenic shock complicating acute myocardial infarction\u2014incidence and mortality from a community wide perspective 1975\u20131988","volume":"340","author":"Goldberg","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jchf.2013.02.007","article-title":"Heart failure complicating non-ST-segment elevation acute coronary syndrome: Timing, predictors, and clinical outcomes","volume":"1","author":"Bahit","year":"2013","journal-title":"JACC Heart Fail."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1056\/NEJM199908263410901","article-title":"Early revascularization in acute myocardial infarction complicated by cardiogenic shock","volume":"341","author":"Hochman","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1161\/CIR.0000000000000336","article-title":"2015 ACC\/AHA\/SCAI Focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: An update of the 2011 ACCF\/AHA\/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF\/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions","volume":"133","author":"Levine","year":"2016","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1093\/eurheartj\/ehx393","article-title":"2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)","volume":"32","author":"Ibanez","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Hashmi, K.A., Abbas, K., Hashmi, A.A., Irfan, M., Edhi, M.M., Ali, N., and Khan, A. (2018). In-hospital mortality of patients with cardiogenic shock after acute myocardial infarction; impact of early revascularization. BMC Res. Notes, 11.","DOI":"10.1186\/s13104-018-3830-7"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1002\/clc.23168","article-title":"Management of cardiogenic shock complicating acute myocardial infarction: A review","volume":"42","author":"Shah","year":"2019","journal-title":"Clin. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.ccc.2014.03.001","article-title":"Cardiogenic shock","volume":"30","author":"Shah","year":"2014","journal-title":"Crit. Care Clin."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1007\/s12928-017-0490-9","article-title":"In-hospital outcomes of acute myocardial infarction with cardiogenic shock caused by right coronary artery occlusion vs. left coronary artery occlusion","volume":"33","author":"Taniguchi","year":"2018","journal-title":"Cardiovasc. Interv. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.jchf.2014.10.007","article-title":"Incidence, temporal trends, and prognostic impact of heart failure complicating acute myocardial infarction: The SWEDEHEART Registry (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies): A study of 199,851 patients admitted with index acute myocardial infarctions, 1996 to 2008","volume":"3","author":"Desta","year":"2015","journal-title":"JACC Heart Fail."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1002\/clc.22580","article-title":"Cardiogenic shock predicts long-term mortality in hospital survivors of STEMI treated with primary percutaneous coronary intervention","volume":"39","author":"Hemradj","year":"2016","journal-title":"Clin. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e000405","DOI":"10.1136\/openhrt-2016-000405","article-title":"Mortality pattern and cause of death in a long-term follow-up of patients with STEMI treated with primary PCI","volume":"3","author":"Moloi","year":"2016","journal-title":"Open Heart"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1177\/2048872614561480","article-title":"Shock-index as a novel predictor of long-term outcome following primary percutaneous coronary intervention","volume":"4","author":"Spyridopoulos","year":"2015","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1177\/2048872616673535","article-title":"CREDO-Kyoto AMI investigators. Long-term clinical outcomes in patients with ST-segment elevation acute myocardial infarction complicated by cardiogenic shock due to acute pump failure","volume":"7","author":"Kawaji","year":"2018","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1001\/jama.295.21.2511","article-title":"Early revascularization and long-term survival in cardiogenic shock complicating acute myocardial infarction","volume":"295","author":"Hochman","year":"2006","journal-title":"JAMA"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1161\/CIRCULATIONAHA.118.038201","article-title":"Intraaortic balloon pump in cardiogenic shock complicating acute myocardial infarction: Long-term 6-year outcome of the randomized IABP-SHOCK II trial","volume":"139","author":"Thiele","year":"2019","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e000590","DOI":"10.1161\/JAHA.113.000590","article-title":"Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States","volume":"3","author":"Kolte","year":"2014","journal-title":"J. Am. Heart Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e003522","DOI":"10.1161\/JAHA.116.003522","article-title":"Acute kidney injury definition and in-hospital mortality in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction","volume":"5","author":"Marenzi","year":"2016","journal-title":"J. Am. Heart Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"170","DOI":"10.7326\/0003-4819-150-3-200902030-00006","article-title":"Contrast volume during primary percutaneous coronary intervention and subsequent contrast-induced nephropathy and mortality","volume":"150","author":"Marenzi","year":"2009","journal-title":"Ann. Intern Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0195-668X(02)00799-6","article-title":"The logistic Euro-SCORE","volume":"24","author":"Roques","year":"2003","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1161\/CIRCULATIONAHA.108.814947","article-title":"Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: A population-based perspective","volume":"119","author":"Goldberg","year":"2009","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2535","DOI":"10.1093\/eurheartj\/ehs264","article-title":"Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: A report from the USIK 1995, USIC 2000, and FAST-MI French Nationwide Registries","volume":"33","author":"Aissaoui","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1016\/j.jacc.2017.02.027","article-title":"Risk stratification for patients in cardiogenic shock after acute myocardial infarction","volume":"69","author":"Fuernau","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1016\/j.ahj.2009.08.005","article-title":"Predictors of 30-day mortality in patients with refractory cardiogenic shock following acute myocardial infarction despite a patent infarct artery","volume":"158","author":"Katz","year":"2009","journal-title":"Am. Heart J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1136\/hrt.2003.021691","article-title":"Predictors of outcome after percutaneous treatment for cardiogenic shock","volume":"91","author":"Sutton","year":"2005","journal-title":"Heart"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/j.acvd.2018.01.002","article-title":"Temporal trends in clinical characteristics and management according to sex in patients with cardiogenic shock after acute myocardial infarction: The FAST-MI programme","volume":"111","author":"Isorni","year":"2018","journal-title":"Arch. Cardiovasc. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1177\/2048872617719638","article-title":"Predicting two-year mortality from discharge after acute coronary syndrome: An internationally-based risk score","volume":"8","author":"Pocock","year":"2019","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/clc.23116","article-title":"Predictors of all-cause mortality and ischemic events within and beyond 1 year after an acute coronary syndrome: Results from the EPICOR registry","volume":"42","author":"Rossello","year":"2019","journal-title":"Clin. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1002\/ccd.22911","article-title":"Cardiogenic shock complicating acute myocardial infarction in the elderly: Predictors of long-term survival","volume":"78","author":"Tomassini","year":"2011","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1097\/CCM.0b013e3181b9eb3b","article-title":"Acute kidney injury in ST-segment elevation acute myocardial infarction complicated by cardiogenic shock at admission","volume":"38","author":"Marenzi","year":"2010","journal-title":"Crit. Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Garc\u00eda, C., Oliveras, T., El Ouaddi, N., Rueda, F., Serra, J., Labata, C., Ferrer, M., Cediel, G., Montero, S., and Mart\u00ednez, M.J. (2020). Short- and Long-Term Mortality Trends in STEMI-Cardiogenic Shock over Three Decades (1989\u20132018): The Ruti-STEMI-Shock Registry. J. Clin. Med., 9.","DOI":"10.3390\/jcm9082398"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/11\/2237\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:05:31Z","timestamp":1760162731000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/11\/2237"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,21]]},"references-count":31,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["jcm10112237"],"URL":"https:\/\/doi.org\/10.3390\/jcm10112237","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,21]]}}}